Working With High-Risk And Most Vulnerable Mental Health Populations With Jill FitzGerald

Working With High-Risk And Most Vulnerable Mental Health Populations With Jill FitzGerald

[00:00:00] John Cordray: When I worked in a school district several years ago, the reason why I worked there and they hired me is to work with kids who were high-risk. They scored very high on the ACEs score, and some of you may have heard me talk about that in other episodes, and they were high risk because they came from, a very traumatic background and environment.

[00:00:24] John Cordray: Part of my job was to help them, and help teachers and staff help the students as well. And today I'm really looking forward to talking about this because it's where a lot of my experience is as well. And the title of this episode is called Working with High Risk in Most Vulnerable Mental Health Populations with Jill Fitzgerald.

[00:00:47] John Cordray: Coming right up. 

[00:00:48] John Cordray: Welcome to the Mental Health Today Show. My name is John Cordray and I am a licensed therapist I am the host of this show, and I'm very happy that you're here and you're tuning in. I have a very special guest with [00:01:00] me today.

[00:01:00] John Cordray: I'm gonna just tell you her bio and we'll get right. So Jill Fitzgerald is a licensed social worker and she's a Senior Vice President of clinical operations at Confident Health. She's also a clinical leader in operations expert. She has designed and implemented innovative care team models across multiple states and care settings to align high quality behavioral health service delivery with value based payment.

[00:01:29] John Cordray: At Confident Health, Jill is designing the future of virtual care for addiction by leveraging both her clinical expertise and the use of technology to support data driven care team model design, implementation, and innovation efficiency. Wow, that's a lot. Jill has worked with some of the most high risk, high need and vulnerable populations in her 20 years of experience in the behavioral health.

[00:01:57] John Cordray: She has worked as a forensic interviewer [00:02:00] in the child welfare system as a family and criminal court expert, witness as an adjunct faculty member, as a leader of evidence-based assertive community treatment models to support individuals with serious mental illness and as a leader of care team models she designed and implemented specific to individuals with complex medical and behavioral health.

[00:02:24] John Cordray: Jill received her bachelor's degree in social work from the University of Vermont and her master's degree in clinical social work with a specialization in law from Fordham University in addition to her professional work. Jill is a mom, marathon rudder, and a hot power yoga fan, and she lives in New Hampshire with her family and cat Dumbledor.

[00:02:49] John Cordray: Oh, I love that name. Welcome, Jill, to the. 

[00:02:53] Jill FitzGerald: Thank you, John, for having me. Super excited to be here. The cat's name is Elvis Dumbledore. Just to [00:03:00] clarify, , 

[00:03:01] John Cordray: thank you for that clarification. So, alright, nice. So I, I really liked the the last part there of your bio that you talk about. You're a person too, you're a mom and a marathon runner and a hot power yoga fan.

[00:03:16] John Cordray: I love all that. I love talking about the backstory of professionals. How they got into the profession. And would you mind just kind of telling us a little bit about your backstory and then how you got into this profession? Yeah, for 

[00:03:32] Jill FitzGerald: sure. So I have been in the social work field really since my freshman year of undergraduate.

[00:03:41] Jill FitzGerald: I went to University of Vermont, was sort of exploring if I wanted to, you know, major in psychology or social work and trying to sort of find my niche along the way and did an internship at a place in Vermont. It was called the Lu Family Center, [00:04:00] and it was working with pregnant and parent. Teenage women who were sort of trying to navigate that journey and trying to ensure that they were sort of developing those independent living skills to be able to be successful, both in their role as mom and in their role as just sort of whatever they saw as their life trajectory.

[00:04:21] Jill FitzGerald: And so that internship experience is really powerful for me. I really got a sense of all of the different elements that a person experiences in their lives from sort of the social determinants of health to sort of defining roles and goals for ourselves. And so I really found that experience to be really empowering both in my work there, but also in sort of driving what I wanted to do.

[00:04:46] Jill FitzGerald: You know, as my career progressed, and so I, I really felt strongly that social work was where I wanted to be. The, you know, the training and education was really looking at the whole person, the environment, family [00:05:00] systems, and really trying to understand. Everything that goes into, you know, discovering, healing and, and meaningful growth for individuals.

[00:05:08] Jill FitzGerald: So that was kind of my first exposure to social work and really sort of laid the groundwork for, for my growth as a professional moving forward. 

[00:05:18] John Cordray: Well, that's really cool and, and you make it sound so easy, but I know there's a lot of time, energy, blood, sweat, and tears went into 

[00:05:26] Jill FitzGerald: all. Yes, for sure. I mean, I think that, you know, that experience really showed me, you know, the impact of trauma, as you mentioned before, the ACEs and sort of the experiences that people have in their early childhood years and how that shapes, you know, sort of how they develop into adolescents and adulthood.

[00:05:44] Jill FitzGerald: And so that was really my first look at the impact of trauma. The importance as, as clinical professionals and really understanding that and coming to the work from a trauma informed space. 

[00:05:58] John Cordray: Yeah, and I noticed that you [00:06:00] were a forensic interviewer. You worked in the, the child welfare system and I got a, a little taste of that when I worked in the schools.

[00:06:08] John Cordray: I was on the child protection team meeting. We met once a month and we looked through all of the, the kids who had a hot. And we wanted to see if they needed to do an investigation or not. So it was an eye opening experience for me. But for you, I'm sure you worked in the system all the time. Can you tell us a little bit about what is a forensic interviewer and what were some of the things that you experience working in the child welfare system?

[00:06:40] Jill FitzGerald: Yeah, so my first experience with the child welfare system was when right after I graduated from the University of Vermont, I moved to South Carolina. Was looking for a little bit of a difference in weather After so many cold, cold winters in Vermont and fell, fell into a position at the Department of Social [00:07:00] Services in Charleston where.

[00:07:01] Jill FitzGerald: Initially an investigative case worker and then moved into a foster care case worker role where I was, you know, really getting a sense of what the experience was for the child in the system also, but for the family system, both on the foster care provider side and also. You know, the biological family side.

[00:07:23] Jill FitzGerald: And so I really got a sense through that experience of all the different ways that our system can, can impact children and families and all the different sort of moments that, you know, social workers, clinicians, whatever the role is, have a chance to impact. And so that was a wonderful experience for me.

[00:07:43] Jill FitzGerald: You know, I, I took what I learned there, moved to New York City and took a similar role in New York City, and so really got a chance to see all the different. Experiences that children and families have in this system, both at the rural and urban levels. [00:08:00] And so that was really great too. You know, for me, growing up in New Hampshire, I had never experienced a city atmosphere and especially a city atmosphere in the child welfare system.

[00:08:09] Jill FitzGerald: So that really gave me a lot of tools to sort of transition into that. Forensic interviewer role. When I graduated from Fordham University with my master's in social work, I moved back to Charleston. Loved it there, still miss it. And I decided that I wanted to take a position as a forensic interviewer at a child advocacy center.

[00:08:30] Jill FitzGerald: And so basically what that means is children or families who, you know, have someone in their family network that may have been exposed to abused and or neglect would come to this center and it. Was allowing for them to not have to repeatedly tell their story to a number of different professionals.

[00:08:50] Jill FitzGerald: That was really important because when we're thinking about care from a trauma informed perspective, you know, children having to tell their stories to a police officer, to a social worker, to [00:09:00] a doctor, you know, that can be really retraumatizing for the, for the child and also for the family system. And so the role of forensic interviewer really was to eliminate that and to really develop that therapeutic relationship with the child and make sure that they felt safe, comfortable, that the questions were clinically informed and trauma inform.

[00:09:19] Jill FitzGerald: And so that was really my first role out of grad school was, you know, making sure that children who had been exposed to abuse or neglect had a safe place to tell their story and had a safe place to get treatment following that disclosure. Well, I 

[00:09:35] John Cordray: think that's fantastic and it must have been exciting and heartbreaking at the same time.

[00:09:42] Jill FitzGerald: For sure. I remember, you know, probably about two or three years into my work, I remember thinking at one point, sort of visualizing my. You know, abilities as a clinician, as sort of a cup, you know? And so we wanna make sure that [00:10:00] we always have room in that cup for more, so that we can really hold that space for whoever it is that we're working with.

[00:10:06] Jill FitzGerald: And I remember at one point thinking, Wow, this, this cup is getting ready to overflow. It is hard as a clinician to hear those types of stories and those experiences, real experiences that people have had, children have had, you know, sort of over and over again and. That was really probably the first time in my career I recognized the importance of self care and the importance of self-reflection as a clinician and really making sure that I was prepared to hold that space and that I was taking care of myself in a way that would allow for me to do so.

[00:10:39] John Cordray: Yeah, and I think that's so important to stress. For all the providers that are listening to this that you've heard me talk about self care, but when you are constantly client facing and you have clients that you're talking to and you're listening and you're hearing their burdens and their deepest struggles and [00:11:00] they're telling you, and it's an honor actually to hear that and to walk with someone, but it's also can be.

[00:11:07] John Cordray: And I know for me, before I went into the schools, I had a private practice for 10 years, but nothing as heavy as experience in the private practice as I felt in working in the schools because of their kids and their children and adolescents who have gone through abuse. And I mentioned ACEs before and someone might be listening or what is.

[00:11:30] John Cordray: Just wanna real quickly go over that real quick so you know, give you a context. ACEs means adverse childhood experiences and it's a way that we are able to identify out of 10 questions that the CDC in the hospital in California created in the late nineties. There are 10 question. And they're based on childhood experiences.

[00:11:54] John Cordray: So we use that in the schools and I know a lot of other providers use it as well to [00:12:00] indicate how high of a score, one out of 10 or zero outta 10 and higher the score, the more severe the trauma was. So that's what ACEs is and what Jill's talking about working in that, that population. That's exactly, there are multiple A score.

[00:12:17] John Cordray: And going through and, and having abuse as an A score. And usually there's one, a score, there's multiple. And so Joe, I, I would imagine that you worked with kids and adolescents with pretty high a scores. 

[00:12:30] Jill FitzGerald: Definitely. And you know, when we're looking at it as clinicians, it's, you know, it's a scoring of 10, right?

[00:12:36] Jill FitzGerald: And so anything over four is considered clinically significant. And you know, the children that I was seeing, And even, you know, further on in my career, some of the adults I've worked with, their scores are, you know, 8, 9, 10. We're really, you know, we're working with people that have been exposed to complex persistent trauma throughout their childhoods and you know, that really does.[00:13:00] 

[00:13:00] Jill FitzGerald: Sort of, you know, and that study shows that there is a direct link between those types of adverse experiences and, you know, struggles later on in life with, you know, either medical diagnoses or mental health, substance use, alcohol use. And so, you know, people who have experienced those adverse.

[00:13:19] Jill FitzGerald: Experiences in childhood without treatment and without addressing those in a real meaningful way with a clinician who truly, you know, gets it and is trained to do it, they are more likely to develop some of those things as they transition into adulthood. Yeah, 

[00:13:33] John Cordray: exactly. And one of the things, the common denominator that I found working with the kids with a high A scores their parents to, had 'em hide too, and it just passed on down to generat.

[00:13:45] John Cordray: For 

[00:13:45] Jill FitzGerald: sure. Yep. You know, a lot of the, the work that I've done has really sort of highlighted that, that generational trauma and, you know, so when you're working with, you know, say a child who has a high acore, you really are [00:14:00] looking at working with the whole family system. It really is sort of that comprehensive approach to ensure that that generational trauma does not continue to exist moving forward.

[00:14:10] John Cordray: Yeah, that's so critical. So you have had a lot of great experience working with the high risk and most vulnerable mental health populations, and now you're working with a company called Confident Health. So tell me a little bit, how did you get involved and start working for Confident Health, and then what does Confident Health do?

[00:14:35] John Cordray: Sure. 

[00:14:35] Jill FitzGerald: Yeah. So. You know, as I grew in my career, I ended up moving back to the Northeast. I started running a program in Massachusetts for. Adults diagnosed with persistent mental illness and really working, you know, with the very vulnerable population who had spent, you know, years in state hospital and trying to support them in transitioning into a community based [00:15:00] setting and doing so in a way that was going to be sustainable and meaningful for them.

[00:15:03] Jill FitzGerald: And, you know, making those connections in their communities. And so that was really, You know, when I transitioned from, you know, just providing that direct work as a clinician into more of a leadership, an administrative role, and you know, that experience was wonderful. You know, and then, From there, transition to a nonprofit in the New England area and again, you know, sort of developing those leadership skills and really working on program design development and scale.

[00:15:32] Jill FitzGerald: And so for the past eight or nine years, I. Have been very focused on identifying service gaps in communities, you know, across states and, and designing and developing programs to meet those gaps. And, and one of those, those programs that I developed was really focused on, you know, how do we look at the whole person, you know, somebody who has complex medical, behavioral health needs.

[00:15:56] Jill FitzGerald: How do we wrap around that person in a way that supports them in making [00:16:00] those meaningful connections in their community for selfsufficiency? Sort of long term agency in their journey, whatever that looks like for them. And so that's really what drove me to Confidant. And, you know, I, I met the founders and really felt very passionate about what Confidant was doing.

[00:16:19] Jill FitzGerald: It was very aligned with a lot of the programs I had developed previously. And so I think that that sort of describes the transition and, you know, I'm super thankful to be there now, confidant. Provides, you know, it's sort of a tech enabled virtual care provider. And so it's this combination of digitized behavioral health resources and direct connection with a virtual care team.

[00:16:47] Jill FitzGerald: And so, you know, that's very aligned with the work that I've sort of done throughout my career is working from a multidisciplinary team environment where we're really looking at the whole person. We're looking at [00:17:00] things like the social determinants of health. We're looking. Data, we're allowing that to drive care, but most importantly, we're putting the person that is being served in the driver's seat of their care.

[00:17:12] Jill FitzGerald: They are the most important person and member of the team. And so really ensuring that we, you know, deliver our services in a way that really supports that. So at Confidant we, you know, provide these virtual care services to adults and to adults who may be struggling with substance use, alcohol use, and or mental health symptoms that, you know, they're looking for support with.

[00:17:38] Jill FitzGerald: And it really, it really does meet the individual where they're at. So, you know, we're, we're working with people. You know, may just sort of be trying to explore their relationship with substances or alcohol or mental health, and they're not necessarily ready to make any, any significant or big change, but they're really just trying to understand how those relationships are working for them.

[00:17:59] Jill FitzGerald: [00:18:00] All the way up to individuals who, you know, meet criteria for a mental health diagnosis or substance use disorder, alcohol use disorder, and are looking for sort of that comprehensive wraparound treatment, including medication for addiction treatment, individual therapy groups, and you know, sort of all the supports that, that someone may need to go through that process.

[00:18:23] John Cordray: So the services at Confidant Health is just absolutely critical. It's so needed. And my question is, is it offered in every state or is it right now only offered in select 

[00:18:35] Jill FitzGerald: states? Great question. So currently we are operating in Connecticut and Virginia. And we have plans to launch in Texas and Florida this year as well.

[00:18:47] Jill FitzGerald: You know, and that is for what I was just sort of describing as that, that comprehensive service where somebody is needing medication and therapy and is really wanting that wraparound support. For [00:19:00] individuals who may not need that level of care, but maybe looking for a recovery coach or maybe looking to attend groups.

[00:19:07] Jill FitzGerald: People can attend those throughout the country. We can provide those services everywhere, but for individuals that are looking to meet with a nurse practitioner or to meet with a therapist, currently it is in Connecticut and Virginia with plans to. 

[00:19:20] John Cordray: Well, that's great. That's fantastic. I love talking about opening access to this type of service and that's exactly what Confident Health is, is doing.

[00:19:30] John Cordray: So you mentioned it's for adults. So someone is, say from one of these states that you're operating in and they're interested in finding out more, what's the process? I'm assuming they, they sign in or sign up for? To talk to somebody. Does someone then get back with them and walk them through it, or is there a different process?

[00:19:52] Jill FitzGerald: That's a great question and I think before going there, I think it's important to also sort of, you know, make note of the fact [00:20:00] that anybody can access the Confidant app. And so, you know, for people that may just want to explore. What confidant has to offer or wants to explore some of our content or you know, our DIY sort of self-guided behavior change platform.

[00:20:19] Jill FitzGerald: Anyone can do that anywhere. And so typically, you know, people will download the app and they are outreached by our matchmaker, which is similar in theory to sort of like a, a care manager or. You know, Care navigator, the matchmaker reaches out to them, sort of orients them to the app, makes sure they don't have any questions, sort of lets them know all the different ways that they can interact with the app on the DIY side, but then also if they're looking to connect with a provider.

[00:20:51] John Cordray: Well, that's great. I'm glad that you mentioned the app, and I'm glad that you mentioned just because you're not in every state, anybody can download it. Anybody can [00:21:00] get the resources from it. So I'm really happy that you mentioned. 

[00:21:03] Jill FitzGerald: Yeah, absolutely. And there, you know, there's over 600 pieces of content in the app and that's growing daily.

[00:21:11] Jill FitzGerald: So lots of different strategies and resources for people that may not be ready to engage with a provider, but maybe looking to sort of, you know, see what's out there in terms of ways to improve their overall quality of life. So, you know, topics like anxiety, depression, substance use, sleep hygiene, all sorts of things that people can access to, to sort of do on their own if they're not quite ready for that higher level.

[00:21:37] John Cordray: Wow, that's fantastic. And I think it's a real easy way to get the resources. There might be someone out there, maybe a loved one, maybe a parent that's thinking, Where do I turn for my child? Or where do I turn for my adult child? Where do I turn for my spouse because they're addicted in? And this is a, a great way, a great resource.

[00:21:58] John Cordray: Just go to the app. [00:22:00] And I'm assuming it's both in the Apple and and as well as Android app. 

[00:22:04] Jill FitzGerald: Yes. Yep. Absolutely. And you, and you bring up a good point about the family member. That is something that we are really focused on at confidant. So you know, obviously meeting the individual where they're at and supporting them while also recognizing the impact that substance use, alcohol use or mental health can have on the family members as well.

[00:22:25] Jill FitzGerald: And so we have a really well attend, Family support group within the app and so anybody can access that. And it really is an amazing community of family members who are, you know, sort of seeking that support and seeking that, that guidance surrounding how to manage, you know, the struggles that they may be having with someone in their life who could be experiencing any one of those things.

[00:22:52] John Cordray: Oh, I love it. I love that. That is so, so important. So I know a lot of people who are, who are [00:23:00] addicted to a substance abuse, and a lot of times they don't come to the conclusion, Oh, I need to get help. Or maybe they do, but they don't, They don't know where to turn. So it's, it's a repeated cycle of addiction, and yet somebody might be listening to this and they realize that, Yeah, I'm addicted.

[00:23:20] John Cordray: I need to get help. What are, what are a few things that you would tell that person? 

[00:23:26] Jill FitzGerald: Yeah, I mean, I think first just to validate their experience, you know, I think that it's really important to make sure that people feel heard and that, that you're holding the space for that. And so, you know, I think that one of the things that there's a, a number of things that make it difficult for people to access, you know, high quality treatment, but, you know, historically treatment specifically for, for substance use or alcohol use, you know, has.

[00:23:54] Jill FitzGerald: Facility based and has been, you know, sort of abstinence based and, and we are really taking a [00:24:00] very different approach to that. We really feel. Strongly that access to care is really important. There are people out there that need help and they need help yesterday. And so making sure that our services are accessible is really, really important to us.

[00:24:17] Jill FitzGerald: And so, you know, through the use of technology, people are able to access this care from their couch, from their car, whatever is most convenient for them, you know? And I think a lot of the traditional treatment models, you know, are, are sort of delivered in that nine to five setting and. For many people who work or you know, don't have childcare, that just, that just doesn't work for them.

[00:24:38] Jill FitzGerald: And so making sure that we, you know, are flexible and meeting the needs of individuals outside of those traditional hours is, is also really important to us. And so, you know, I think I would say that, you know, confidant, we're, we're approaching this, you know, abstinence is not required to come work with us.

[00:24:55] Jill FitzGerald: We wanna make sure that we. Having the individual that's [00:25:00] seeking care in the driver's seat of their journey. So if we're exploring what the relationship is with substances or alcohol, that's a great place to start and we wanna make sure that people feel welcome, whether or not they're ready to make those big changes.

[00:25:14] John Cordray: Well, I think that's really important. To emphasize is that come as you are, there are no expectations. Absolutely. You don't have to have it altogether. You don't have it all together. That's why you're addicted. There's a reason why you're addicted, and now is the time. If you're listening to this, this episode, or if you're a loved one who has someone who's addicted, I wanna encourage you to share this episode with.

[00:25:40] John Cordray: Because there is a reason why you are addicted and it, it could be trauma that we talked about earlier. Maybe, maybe your A score is very high and we know from, from research and just our own experience that people who are addicted, that they seek out self-medication [00:26:00] for a reason. It's cuz they're hurting.

[00:26:03] John Cordray: And so there's gotta be a time in your life where you recognize that and you look around you with the people that you love, that who love you the most. They want you to get better and to get sober. And now this is your wake up call. This is the time where you cannot keep saying, in making up all these excuses.

[00:26:23] John Cordray: I mean, Jill just said, you can do it right from your couch, , it doesn't get much more convenient than. Just go to the App store, type in Confident Health, download the app and start your journey. There's no expectations or there's no strings attached, and I love the fact that Confident Health just makes access so, so much easier now.

[00:26:46] John Cordray: Wonderful. Well, Jill, thank you so much for talking about just your experience, your personal experience and your background, but also what you're doing at Confident. But before I let you go, there's a [00:27:00] question that I ask all of my guests and it has to do with self care. And I do talk a lot about self care and it is so important, you know, as professionals, mental health, professional, that self care is important for us.

[00:27:12] John Cordray: But I'm curious, what are some things that you do for your self care? 

[00:27:16] Jill FitzGerald: That's a great question. So, you know, I. I think that has evolved over time and my ability to self reflect on when I need it and when I need to be engaging in it is also has evolved over time and I think that just comes with practice and self-awareness and, and making sure that I'm checking in with myself.

[00:27:37] Jill FitzGerald: I'm naturally drawn to physical exercise, and so, you know, as you said before, I'm a marathon runner. Some people, you know, would not find that to be self care. But for me, I, I really appreciate a routine. I appreciate a goal, I appreciate, you know, community in that. And so for me, things like yoga, running and really just sort of having [00:28:00] something that is just for myself is, is really important.

[00:28:03] Jill FitzGerald: And, you know, I think. Something else to consider is self care looks different for everybody, right? So what I find to be meaningful and restorative, other people may not. And so it's really trying to understand your journey and what works for you. And you know, I've been known to watch some reality television on TV once in a while, and that also.

[00:28:25] Jill FitzGerald: You know, for me works, it's a distraction. It's something where I'm not sort of in my head thinking about the day's events, and so I think it's really, you know, from a clinician's perspective, really figuring out what that is and, and knowing that it's okay if that evolves and changes over time. 

[00:28:40] John Cordray: Oh, I, I just absolutely love that, that you're so right.

[00:28:43] John Cordray: Self care and our interests tend to evolve over time as we develop ourselves, as we get older. I just, I love that, that little tip there on self-care. Thank you for sharing that, and I wanna thank all of you for listening to the show, to this episode in particular, this [00:29:00] is something that really, it affects all of us, and most of you who are listening to this probably can identify at least one person in your life that's gone through addiction.

[00:29:11] John Cordray: You could probably identify at least one person who's gone through trauma, maybe that. So this episode is really, really important and I, I wanna encourage you, maybe even listen to it again because it affects all of. So thank you so much for listening to this show. I appreciate you so much, and I continue to work on your mental health because the Mental Health Today Show has been championing your mental health since 2015.

[00:29:40] John Cordray: Take care. Bye-bye.